Infections

Question 1

define myocarditis

Answer 1

inflammation of the myocardium

Question 2

infectious causes of myocarditis

Answer 2

coxsackie A and B
echo virus
Chaga's disease
HIV
Lyme's disease

Question 3

type 3 hypersensitivity causes of myocarditis

Answer 3

• rheumatic fever

- drugs

Question 4

other causes of myocarditis

Answer 4

SLE

Question 5

presentation of myocarditis

Answer 5

• fever
• chest pain, palpitations
• SOB
• arrhythmias and cardiac failure

Question 6

diagnosis of myocarditis

Answer 6

• PCR viral
• echocardiogram
• bloods
• ECG, CK, troponin and CXR should be ordered for anyone presenting with chest pain and SOB

Question 7

management of myocarditis

Answer 7

• if weakened heart then reduce workload with ACEI/ARB
• cardiogenic shock then intra-aortic balloon pump
• antibiotics

Question 8

define pericarditis

Answer 8

this is inflammation of the pericardium

Question 9

what does pericarditis often occur with?

Answer 9

myocarditis

Question 10

causes of pericarditis

Answer 10

• infection
• uraemia
• post MI (Dressler’s syndrome 4-6 weeks following MI)
• post-surgery
• SLE

Question 11

presentation of pericarditis

Answer 11

• pleuritic chest pain that is relieved by sitting up and leaning forward
• fever

Question 12

diagnosis of pericarditis

Answer 12

• ECG (shade-shaped ST elevation)

- bloods

Question 13

management of pericarditis

Answer 13

• if tamponade then pericardiocentesis
• vancomycin
• NSAIDS, PPIs

Question 14

define infective endocarditis

Answer 14

this is inflammation of the endocardium, often including the heart valves

Question 15

causes of infective endocarditis

Answer 15

• IV drug abuse= candida, staph aureus
• atypical = HACEK (gram -ve)
• rheumatic heart disease
• SLE

Question 16

HACEK

Answer 16

Haemophilus
Aggregatibacter
Cardiobacterium
Eikenella
Kingella

Question 17

presentation of infective endocarditis

Answer 17

• night sweats
• malaise
• weight loss
• Osler’s nodes and Janeway lesions (subacute)
• Roth spots
• splinter haemorrhages
• sepsis (staph aureus)

Question 18

diagnosis of infective endocarditis

Answer 18

• duke’s criteria (bloods)
• echocardiogram
• serology and PCR

Question 19

management of endocarditis in a prosthetic valve or MRSA

Answer 19

vancomycin, gentamicin and rifampicin (3-5 days after)

Question 20

native valve management in endocarditis (strep viridian’s)

Answer 20

amoxicillin and gentamicin

Question 21

drug users endocarditis

Answer 21

flucloxacillin